C-sections: Not so benign after all, eh?

Two studies have recently come out which highlight the risks of cesarean birth for both mothers and babies, particularly primary cesareans with no medical indication. A recent study printed in Birth: Issues in Perinatal Care found that neonatal mortality rates were higher in babies born by cesarean, even after the statistics had been adjusted for congenital malformations, socioeconomic and medical risk factors. This is especially significant given that the focus of the study was on low-risk mothers who had no medical indication for cesarean, and the sample size was quite large (311,927 low risk women were analyzed). The NY Times picked up the story in last Tuesday’s paper (Voluntary C-sections Result in More Baby Deaths).

And then, it never rains but it pours: Nabbed from Milliner’s Dream, who saw it first, a recent French study also found that having a cesarean more than triples a woman’s risk of death when compared to the risks associated with a vaginal birth. (Postpartum Maternal Mortality and Cesarean Delivery) The increased risk of death was found to stem from complications from anesthesia, puerperal infection and venous thromboembolism, all of which are risks associated with surgery.

So, how…vindicating. There is now a sudden spurt of evidence which suggests that cesareans aren’t nearly as safe or benign as common practice would indicate. Now the question is: how long will it take for the medical community to absorb this new information and begin to cite the risks involved to the women trying to schedule a primary cesarean when there is absolutely no medical indication for one? It took years for the medical community to acknowledge that routine episiotomy can cause more harm than good, but practic is finally beginning to change. And, I wonder who will be the first to try to refute these findings?

(By the way, have you noticed how chock-full of good stuff the September issue of Obstetrics & Gynecology is? In addition to the above French study on maternal mortality and c-sections, check out ACOG’s Committee Opinion on the HPV vaccine).

ADDENDUM:

ACOG’s press release on the results of the French study in this month’s Obstetrics & Gynecology :

Though rates of maternal death in most developed countries are relatively low—US women have a 1 in 3,500 chance of pregnancy-related death—incidences of maternal mortality have not significantly decreased in the last two decades. These study results suggest that mode of delivery may be a modifiable risk factor, and in some cases, choosing vaginal delivery over non-medically indicated cesarean delivery could help lower maternal mortality rates.